“The best therapy for a man suffering impotence…may be a therapist-supplied ‘other woman’ who embodies patience. Actual patience with a willing woman is crucial.” – Quote from the November 1, 1969 San Francisco Chronicle

Some within the sexual health community have argued that the best way to resolve a sexual difficulty is to “practice” with a substitute partner who is very knowledgeable and experienced. Although this idea has garnered a lot of recent attention with the release of the provocative film The Sessions starring Helen Hunt, sex surrogacy first catapulted into the public spotlight in the 1970s when Masters and Johnson publicly advocated for at least some usage of so-called “surrogate” partners in the practice of sex therapy. As part of their pioneering research, Masters and Johnson actually recruited female volunteers to serve as sex surrogates for single men who were experiencing sexual difficulties and achieved a very high rate of success in treating erectile dysfunction. However, this approach was greeted with a great deal of skepticism and concern by both the broader community of sex therapists and the general public alike. So what is the status of sex surrogate therapy today?

We do not know a lot about the nature of modern sex surrogacy from a research standpoint because this therapy continues to remain outside the mainstream; however, we do know that it is practiced and, according to the International Professional Surrogates Association (IPSA), still follows many of the basic principles outlined by Masters and Johnson [1]. For instance, Masters and Johnson advocated for surrogates supplied by the sex therapist (i.e., the therapist should not double as the substitute partner). The therapist and surrogate are thus two separate parts of the therapeutic team. Masters and Johnson also argued that surrogates should basically be anonymous to the client and not share information that could lead them to be personally identified later on.

Who are these sex surrogates? Research suggests that they represent a diverse group of people, including both men and women and persons of all sexual orientations (although it appears that most surrogates are college-educated, heterosexual women [2]). In addition, these therapists do more than just provide a sexual service to their clients. They also spend time providing emotional support, building up social skills, and teaching the client how to relax [2]. The few studies that exist suggest that surrogates can be highly effective in treating both male and female sexual difficulties ranging from erectile and ejaculatory problems [3] to vaginismus [4].

That said, questions about the ethicality and legality of this practice remain. Generally speaking, the major psychiatric and psychological societies consider it unethical for a therapist to have any type of sexual contact with a client, whether it has a therapeutic goal or not. It is easy to understand the ethical concerns here because there is an inherent power discrepancy, the potential for abuse and exploitation, and the possibility of therapeutic harm if unreciprocated feelings develop. Also, legally speaking, many people have likened surrogacy to prostitution (i.e., an exchange of money for sexual services). You can read about how sex surrogates have attempted to navigate these complex issues on the IPSA website and hear out one surrogate's personal story here.

The practice of sex surrogacy continues to be as controversial as when it was first introduced to the public and the debate over it is unlikely to go away any time soon. So where do you stand on the issue? Should sex surrogacy be an option for individuals who desire it? Weigh in with your comments below.

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